Published 4:00 am, Saturday, May 27, 1995

Nowhere are the changes more evident than in the intensive training programs these graduates enter next -- the "residency," where skills are honed by years of hands- on experience.

Under fire for turning out too many specialists and too few generalists, medical schools across the country are cutting back on the number of training spots for would-be surgeons, anesthesiologists and other high-paid practitioners.

At UCSF, administrators plan to cut by 27 percent the number of specialists trained in residency programs over the next five years.

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"It is not a pleasant task," said Dr. James O'Donnell, associate dean for postdoctoral education and the person in charge of implementing the cuts. "Almost all our residency programs here are world-class."

But by 2001, according to a statewide plan, the five UC medical schools will train 400 fewer specialists each year, and slots reserved for generalists -- internists, pediatricians, family practitioners and obstetrician/gynecologists -- will rise to 55 percent.

"We must be responsible in producing the type of physician the state of California needs," said Dr. Haile Debas, dean of the UCSF School of Medicine. "It is not easy, but it is taking place."

Propelling the move toward primary care is widespread consensus among health policy experts that American medicine is oversupplied with specialists who tend to drive up the cost of health care with expensive and sometimes unnecessary procedures.

UC also is feeling pressure from state lawmakers who twice passed bills -- vetoed by Governor Wilson -- mandating more training of primary care doctors and fewer spots for specialists. Wilson instead crafted a voluntary program under which UC is attempting to meet the same goals.

But the real impetus for change is now coming from graduates, who watch warily as the medical marketplace is transformed by the relentless pressure of health maintenance organizations and other providers of "managed care."

"People coming out of specialty training at Ivy League colleges are not getting jobs," said Dr. Cathryn Nation, who is directing the restructuring effort for the UC President's Office. "The managed care companies are looking for general practitioners."

Perry Brown, who graduated from UCSF yesterday, saw the writing on the wall a few years ago and switched his career plans from urology to pediatrics. "There is much more of a demand for primary care doctors, whether it's pediatrics, adult medicine or even geriatrics," he said.

Brown, 26, will start a pediatrics residency in Denver next month and is happy with his choice. "I did my third year in pediatrics at Childrens Hospital Oakland," he said. "I fell in love with the interaction you can have with children and their parents."

The switch toward generalist training at UCSF and other medical schools is good news to Susan Hogeland, executive director of the California Academy of Family Physicians, a group that has spearheaded legislative efforts to tip the balance away from specialists.

"Overall, we are favorably impressed," she said of the UC plans. "But we are still concerned that whenever there is a budget problem at a hospital, it is always the family doctors who find themselves in difficulty, not the orthopedists."